Inflammatory bowel disease in Mexico: Epidemiology, burden of disease, and treatment trends

INTRODUCTION AND AIMS

There is no systematized information for determining/monitoring the burden of inflammatory bowel disease in Mexico. The aim of the present study was to estimate the annual burden of inflammatory bowel disease on the Mexican National Healthcare System, by number of patients seen, hospitalizations, and specific deaths, stratified into age groups.

MATERIALS AND METHODS

Utilizing specific databases of the Mexican National Healthcare System registries coded as ICD-10: K50 and K51, we retrieved and analyzed the data corresponding to the patients seen and hospitalized in 2015, stratified by age group, as well as the specific deaths. Treatment trends among physicians were also examined.

RESULTS

In 2015, 5,009 women (8.1) and 4,944 men (8.4) with Crohn's disease received medical attention (prevalence of cases seen) and 35.1% of those patients were ≥50years of age. In that same period, 17,177 women (27.7) and 15,883 men (26.9) with ulcerative colitis were seen and 31.6% of those patients were ≥50years of age. The hospitalized cases (prevalence of hospitalized cases) were 1,097 patients (0.91) with Crohn's disease and 43.7% of those patients were ≥50years of age; and 5,345 patients (4.42) with ulcerative colitis and 47.6% of those patients were ≥50years of age. Deaths (specific mortality rate) were: 32 women (0.52) and 36 men (0.50) due to Crohn's disease, and 267 women (4.31) and 186 men (3.15) due to ulcerative colitis.

CONCLUSIONS

Inflammatory bowel disease is a burden on the health of Mexican adults and the Mexican National Healthcare System, and it is expected to increase over the next 15years.

Abortion in goats by Caprine alphaherpesvirus 1 in Spain

An abortion outbreak occurred in a goat herd of Murciano-Granadina breed in Almeria Region in Spain where 80 pregnant females aborted. All bacteriological and parasitological examinations resulted negative, whereas virological investigations and real-time PCR assay showed the presence of Caprine alphaherpesvirus 1 DNA in the pathological specimens from aborted foetuses. Nucleotide sequence analysis revealed that the DNA was highly close related to the Swiss strain E-CH (99.7%) and a little less extent to the Italian BA.1 strain (99.4%). Histopathological examination revealed multifocal, well-circumscribed, 50- to 200-μm-diameter foci of coagulative necrosis in the liver, lungs and kidneys of three foetuses. In the periphery of the necrosis, there were frequently epithelial cells with the chromatin emarginated by large, round, amphophilic intranuclear viral inclusion bodies. The source of the infection in the herd could not clearly find out even some hypothesis were formulated. This seems to be the first report of an abortion outbreak due to Caprine alphaherpesvirus 1 in a goat herd in Spain.

Abstract Context Representations in Primate Amygdala and Prefrontal Cortex

Neurons in prefrontal cortex (PFC) encode rules, goals, and other abstract information thought to underlie cognitive, emotional, and behavioral flexibility. Here we show that the amygdala, a brain area traditionally thought to mediate emotions, also encodes abstract information that could underlie this flexibility. Monkeys performed a task in which stimulus-reinforcement contingencies varied between two sets of associations, each defining a context. Reinforcement prediction required identifying a stimulus and knowing the current context. Behavioral evidence indicated that monkeys utilized this information to perform inference and adjust their behavior. Neural representations in both amygdala and PFC reflected the linked sets of associations implicitly defining each context, a process requiring a level of abstraction characteristic of cognitive operations. Surprisingly, when errors were made, the context signal weakened substantially in the amygdala. These data emphasize the importance of maintaining abstract cognitive information in the amygdala to support flexible behavior.

Detection of Cryptosporidium and Giardia in clinical laboratories in Europe--a comparative study

To determine the routine diagnostic methods used and compare the performance in detection of oocysts of Cryptosporidium species and cysts of Giardia intestinalis in faecal samples by European specialist parasitology laboratories and European clinical laboratories. Two sets of seven formalin-preserved faecal samples, one containing cysts of Giardia intestinalis and the other, containing oocysts of Cryptosporidium, were sent to 18 laboratories. Participants were asked to examine the specimens using their routine protocol for detecting these parasites and state the method(s) used. Eighteen laboratories answered the questionnaire. For detection of Giardia, 16 of them used sedimentation/concentration followed by light microscopy. Using this technique the lower limit of detection of Giardia was 17.2 cysts/mL of faeces in the best performing laboratories. Only three of 16 laboratories used fluorescent-conjugated antibody-based microscopy. For detection of Cryptosporidium acid-fast staining was used by 14 of the 17 laboratories that examined the samples. With this technique the lower limit of detection was 976 oocysts/mL of faeces. Fluorescent-conjugated antibody-based microscopy was used by only five of the 17 laboratories. There was variation in the lower limit of detection of cysts of Giardia and oocysts of Cryptosporidium between laboratories using the same basic microscopic methods. Fluorescent-conjugated antibody-based microscopy was not superior to light microscopy under the conditions of this study. There is a need for a larger-scale multi-site comparison of the methods used for the diagnosis of these parasites and the development of a Europe-wide laboratory protocol based upon its findings.

Randomized phase III trial comparing adjuvant paclitaxel/gemcitabine/cisplatin (PGC) to observation in patients with resected invasive bladder cancer: Results of the Spanish Oncology Genitourinary Group (SOGUG) 99/01 study

LBA4518

Background: Approximately half of patients with resected invasive bladder cancer will die within the first three years after surgery due to disease relapse, most of the recurrences being systemic. We have studied in a randomized phase III trial the role of 4 courses of the PGC triplet as compared to observation in this clinical setting.

Methods: Eligibility criteria included: (1) resected high-risk muscle invasive bladder carcinoma (pT3-4 and/or pN+), (2) ECOG PS 0-1, (3) adequate renal function (CrCl > 50 ml/min), (4) ≤ 8 weeks post-cystectomy, (5) no relevant co-morbidities, and (6) signed informed consent. Eligible patients were assigned to observation or 4 courses of PGC (P 80 mg/m2 d1 and 8, G 1000 mg/m2 d1 and 8 and C 70 mg/m2 d1) q21 days. The primary objective was overall survival (OS).

Results: The study was open in July 2000 and prematurely closed due to poor recruitment in July 2007, with 142 patients randomized (74 to observation and to 68 to PGC treatment). Baseline characteristics were well balanced among study arms. Median age was 63 yrs, pT3-4N0: 44%, anyTpN+:56%, PS 0: 59%, median time cystectomy-randomization: 48 days (14-91). In the PGC arm 76% of pts completed all 4 courses of therapy. Main Gr 3-4 toxicities were neutropenia 41%, febrile neutropenia 8%, thrombocytopenia 14%, anemia 5%, fatigue 14%, alopecia 10%, vomiting 8%, renal 5%. There was one toxic death (sepsis). At a median follow up of 30 months (range 1-95), 69 patients have died (45 in control arm and 24 in PGC arm). OS (ITT population) was significantly prolonged in the PCG arm (median NR; 5yr OS: 60%) compared to observation (median 26m; 5yr OS: 31%) (p<0.0009). DFS (p<0.0001), TTP (p<0.0001) and disease specific survival (p<0.0002) were also superior in the PGC arm.

Conclusions: The results of this study strongly suggest that adjuvant PGC improves OS and DFS following cystectomy in high risk invasive bladder cancer. As the study was prematurely closed, the power for firm conclusions is however limited.

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Traction forces exerted by epithelial cell sheets

Whereas the adhesion and migration of individual cells have been well described in terms of physical forces, the mechanics of multicellular assemblies is still poorly understood. Here, we study the behavior of epithelial cells cultured on microfabricated substrates designed to measure cell-to-substrate interactions. These substrates are covered by a dense array of flexible micropillars whose deflection enables us to measure traction forces. They are obtained by lithography and soft replica molding. The pillar deflection is measured by video microscopy and images are analyzed with home-made multiple particle tracking software. First, we have characterized the temporal and spatial distributions of traction forces of cellular assemblies of various sizes. The mechanical force balance within epithelial cell sheets shows that the forces exerted by neighboring cells strongly depend on their relative position in the monolayer: the largest deformations are always localized at the edge of the islands of cells in the active areas of cell protrusions. The average traction stress rapidly decreases from its maximum value at the edge but remains much larger than the inherent noise due to the force resolution of our pillar tracking software, indicating an important mechanical activity inside epithelial cell islands. Moreover, these traction forces vary linearly with the rigidity of the substrate over about two decades, suggesting that cells exert a given amount of deformation rather than a force. Finally, we engineer micropatterned substrates supporting pillars with anisotropic stiffness. On such substrates cellular growth is aligned with respect to the stiffest direction in correlation with the magnitude of the applied traction forces.

Six-month outcome in acute kidney injury requiring renal replacement therapy in the ICU: a multicentre prospective study

OBJECTIVE

To assess quality of life (QOL), mortality rate and renal function 6 months after onset of renal replacement therapy (RRT) for acute kidney injury (AKI) in the ICU.

PARTICIPANTS AND SETTING

This prospective observational study was conducted in seven ICUs in France over 9 months. Inclusion criteria were: age > or =18 years, RRT delivered for AKI and informed consent signed. AKI was defined from the RIFLE score. Recipients of kidney grafts or patients undergoing chronic RRT were not included.

MEASUREMENTS AND RESULTS

QOL was assessed using the Short Form Health Survey (SF-36) questionnaire together with the Index of Activities of Daily Living (ADL) (0: full assistance to 6: no assistance). SF-36 was compared to a reference age- and sex-matched French population. Patient status, place of residence, and persistence of RRT, ADL and SF-36 were assessed at 28 days, 3 months and 6 months from inclusion. In the study period, 205 patients were included and 1 withdrew. At 6 months, 77/204 were alive (mortality 62%). SF-36 and ADL significantly increased from day 28 to 6 months. In the survivors at 6 months, SF-36 items were significantly lower than in the reference population, with the physical items more severely affected than the mental items; 64% were fully autonomous (ADL score = 6); 69% were living in their homes, and 12% were still undergoing RRT; 94% would agree to undergo the same management again.

CONCLUSIONS

ICU survivors from RRT for AKI have an impaired QOL at 6 months, but sustained autonomy in their daily lives.

Freeze-drying of polycaprolactone and poly(D,L-lactic-glycolic) nanoparticles induce minor particle size changes affecting the oral pharmacokinetics of loaded drugs

The present study was geared at identifying the conditions to stabilize poly (D,L-lactic-glycolic) (PLGA) and polycaprolactone (PCL) nanoparticles (NP) by freeze-drying with several cryoprotective agents. Differential scanning calorimetry and freeze-thawing studies were used to optimize the lyophilization process. These studies showed that all samples were totally frozen at -45 degrees C and evidenced the necessity of adding sucrose, glucose, trehalose or gelatine to preserve the properties of NP regardless of the freezing procedure. However, only 20% sucrose and 20% glucose exerted an acceptable lyoprotective effect on PLGA and PCL NP, respectively. Nonetheless, the final to initial size ratios ( approximately 1.5) indicated that particle size was slightly affected in both cases. In vivo studies with CyA-loaded PCL NP whose sizes matched those obtained after NP preparation (100 nm) and after being lyophilized (160 nm) showed that the changes of particle size might have some relevance on drug pharmacokinetics. The MRT was significantly (P<0.05) modified after an oral CyA dose of 5 mg/kg and the treatment with 160-nm sized CyA-loaded NP produced a higher drug partition into the liver of Wistar rats potentially affecting the toxic and immunosuppressive profile of the drug. Therefore, although the particle size changes induced by NP lyophilization were slight, they need to be carefully evaluated and cannot be neglected.

Chronic anisakiasis presenting as a mesenteric mass

Chronic anisakiasis is a rare entity, and its diagnosis is difficult. We report a case of chronic anisakiasis with multiple gastrointestinal manifestations presenting as a palpable mesenteric mass, diagnosed by specific serology and histologic findings. We describe the computed tomographic appearance of this mass and the pathologic correlations. To our knowledge, this is the first time this mesenteric location has been detected by imaging before surgery.

Pharmacokinetics and acute tolerance of a double virus inactivated plasma derived factor VIII concentrate

To further reduce the risk of possible viral disease transmission, an additional virucidal step was performed in the manufacturing process of a solvent/detergent treated factor VIII concentrate, which consisted of heating the lyophilized preparation at 100 degrees C for 30 min (Emoclot DI; ISI, Italy). Because thermal treatment may modify factor VIII bioavailability, the pharmacokinetic parameters and the acute tolerance of the single viral inactivated concentrate (preparation A) were compared with that of the double viral inactivated one (preparation B). Fifteen patients with severe haemophilia A and positive for HAV Ab were enrolled in a double-blind cross-over study and injected with 32.5 IU kg-1 of preparation A and 27 IU kg-1 of the preparation B. No significant differences between terminal half-life, area under the curve/dose, clearance/kg, volume of distribution at the steady state, in vivo recovery and acute tolerance of the two preparations was observed. The only statistical difference was restricted to Cmax.

Pigmented squamous cell carcinoma of the skin: report of two cases and review of the literature

Melanoma is the most common malignant tumor in which melanin synthesis occurs, although other nonmelanocytic tumors synthesize melanin or contain nonneoplastic melanocytes. We present two cases of infiltrating pigmented squamous cell carcinoma of the skin and review the clinical, morphologic, and ultrastructural features. Melanin was found in epithelial tumor cells as well as in macrophages and dendritic melanocytes. Interestingly, one of the neoplasms was associated with an adjacent melanocytic nevus and pigmented solar keratosis. Immunohistochemical analysis showed that neoplastic cells stained for keratin and melanin-filled dendritic cells were found to be S-100 protein and HMB45 positive. A careless examination of the immunohistochemical stains for S-100 protein and HMB45 could cause the misdiagnosis of melanoma, a neoplasm that has a more ominous outlook.

Liquid chromatographic determination of five benzoylurea insecticides in fruit and vegetables

A liquid chromatographic (LC) method was developed to determine 5 benzoylureas--diflubenzuron, hexaflumuron, teflubenzuron, flufenozuron, and lufenuron--in peppers, tomatoes, eggplants, cucumbers, and oranges. Preparation of samples involve extraction with acetone and partitioning into dichloromethane-petroleum ether. A portion of this extract is cleaned up with a solid-phase extraction aminopropyl disposable column. With LC analysis using an RP-8-DB microbore column, acetonitrile-water (70 + 30, v/v) as mobile phase, and photodiode array detection at 254 nm, recovery and repeatability data were collected for the 5 benzoylureas on 4 vegetables and citrus in the range 0.04-2.0 mg/kg. Validated limits of detection and quantitation were 0.01 and 0.04 mg/kg, respectively. The method is reliable for routine analysis of vegetables and fruits.

Combination of ondansetron and droperidol in the prophylaxis of postoperative nausea and vomiting

The aim of this study was to compare the efficacy and safety of ondansetron plus droperidol with each drug alone or placebo in the prevention of postoperative nausea and vomiting (PONV). One hundred females, aged 18-65 yr, ASA physical status I-II, undergoing general anesthesia for elective abdominal surgery were included in a prospective, double-blind, placebo-controlled, randomized study. A standardized anesthetic technique and postoperative analgesia (ketorolac plus patient-controlled analgesia [PCA] with morphine) were used in all patients. Patients were randomly assigned to receive placebo (Group 1, n = 25), droperidol 2.5 mg with induction of anesthesia and 1.25 mg 12 h later (Group 2, n = 25), ondansetron 4 mg with induction (Group 3, n = 25), and ondansetron plus droperidol at the same doses as Groups 3 and 2, respectively (Group 4, n = 25). A complete response, defined as no PONV in 48 h, occurred in 28% of patients in Group 1, 60% in Group 2 (P < 0.05 vs Group 1), 56% in Group 3 (P < 0.05 vs Group 1), and 92% in Group 4 (P < 0.01 vs Groups 1, 2, and 3). Sedation was significantly greater with droperidol (Groups 2 and 4) for 12 h postoperatively. In conclusion, the combination of ondansetron plus droperidol was more effective than each antiemetic alone or placebo in the prevention of PONV in women undergoing elective abdominal surgery.

UV detection of triazine herbicides and their hydroxylated and dealkylated degradation products in well water

The aim of this work was to develop a simple method to confirm the presence of hydroxytriazine products (hydroxyatrazine, hydroxysimazine, hydroxyethylterbutyltriazine and hydroxydiaminotriazine) in water and to apply it to well water samples. The hydroxytriazines were concentrated on a Sep-Pak C18 cartridge. Analysis was performed by HPLC using an RP8-DB column with phosphate buffer (pH 4.7)-acetonitrile (72:28, v/v) as the mobile phase and photodiode-array detection at 233 nm. Hydroxyatrazine, hydroxysimazine and hydroxyethylterbutyltriazine were detected at ppb levels in samples from two shallow wells under a very sandy soil citrus orchard taken at three different times in a 1-year period.

[Tumorous lymphedema of the penis. Report of verrucous elephantiasis. A brief case. Preliminary note]

Exclusively penial lymphatic affections can be considered a highly infrequent occurrence. In the absence of an scrotal oedema, an "elephantiac" involvement with tumoral appearance in the penis, is indeed exceptional. A clinical case is briefly commented here. It refers to a patient with a significant sociopathy who presented a lymphedema confined to the penis in its maximum expression (elephantiasis verrucosa nostras).

Chronic ascites in late onset systemic lupus erythematosus with antiphospholipid antibodies

Because doctors are reluctant to diagnose systemic lupus erythematosus (SLE) in elderly patients, the initial diagnosis in this age group is usually tardy. Furthermore, the presenting manifestations in these patients are commonly atypical. We describe a 72-year-old woman in whom chronic ascites with antiphospholipid antibodies was the initial predominant manifestation of subsequently fatal SLE. Only 13 cases of chronic lupus ascites have been reported in the English and French literature. Our patient represents the first case reported in an elderly person.

Renal duplex scanning: correlation with angiography and isotopic renography

The purpose of this study was to assess the accuracy of Duplex scanning in detecting renovascular disease and to compare it with angiography, renal scintigraphy and captopril test for plasma renin activity and isotopic renography. A Duplex scan was performed in 92 renal arteries (46 patients) and compared to angiography. Three degrees of stenoses were established: 0-60%, 61-99% and occlusion. The peak systolic velocity (PSV) in the renal artery and its ratio to the peak velocity in the aorta (RAR) were used to discriminate stenoses > 60%. PSV in the interlobar arteries was used to assess the relative perfusion of both parenchyma. Angiography demonstrated a stenoses > 60% in 23 hypertensive patients. In all of the patients, plasma renin activity was measured and isotopic renograms (pre- and post-captopril) obtained in order to discriminate hypertension of vascular origin. A PSV in the renal artery > 210 cm/s and a RAR > 3.5 were found to be the diagnostic criteria with the best sensitivity and specificity in detecting stenoses > 60%. Based on these data, Duplex correctly identified 49/54 stenoses > 60%; 28/33 stenoses < 60%; and 5/5 occlusions (kappa 0.79). Sensitivity and specificity in detecting stenoses > 60% were 89.5 and 90.7%, respectively. The ratio between PSV in the interlobar arteries of both parenchyma accurately predicted the relative perfusion (ratio between DTPA uptake in both kidneys) in the isotopic test (n = 23, r = 0.91, p = 0.001). The captopril test (for plasma renin activity and isotopic renography) was positive in only five patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Eccrine squamous syringometaplasia. A prospective clinicopathologic study

Squamous syringometaplasia (SS) is defined as a mature squamous metaplasia of the eccrine ducts. We prospectively evaluated its frequency and clinical and pathological features in a series of 21 patients. SS was found in association with several diseases, chiefly chronic ulcers. The patient' ages ranged between 20 and 80 years and there was no sex predominance. The involved eccrine ducts were usually located in the superficial and mid dermis and displayed inner keratinization. The stimulus required for SS is unknown. Differential diagnosis between SS and well-differentiated squamous cell carcinoma (SCC) depends on the preservation of a lobular configuration and the absence of epithelial dysplasia or invasion.

Adenomyoepithelioma of the breast. A report of two cases

We describe two cases of adenomyoepithelioma of the breast. The two tumors reported herein were well-circumscribed lesions that showed ducts lined by inner epithelial and outer myoepithelial cells and solid areas made up of fasciculated spindle myoepithelial cells. This dual differentiation was corroborated by immunohistochemical studies and electron microscopy.

Long-term survival of a patient with prosthetic valve endocarditis due to Trichosporon beigelii

A case is described of a 49-year-old man with rheumatic aortic valve disease who developed endocarditis seven years after valvular replacement. Trichosporon beigelii was isolated from the blood, a peripheral thrombus, and the removed prosthesis. After two valve prosthesis replacements and prolonged antifungal therapy, the patient survived for four years, but eventually died as a consequence of multiple septic complications due to the same organism. To the authors' knowledge, this is the longest survival time of any reported case of Trichosporon prosthetic valve endocarditis.

Kinetic determination of tellurium based on its inhibitory effect on the palladium(II)-catalysed reaction between pyronine G and hypophosphite ion

A kinetic method for the determination of Te based on its inhibitory effect on the PdII-catalysed reaction between pyronine G and H2PO2- is described. The influence of experimental variables on the rate of the process and the potential interfering effect of a large number of ions has been studied. Under the selected experimental conditions: 6 x 10(-5) M pyronine G; 0.6 M H2PO2-; pH 2.6, adjusted with Britton-Robinson buffer; 0.80 microgram ml-1 of PdII; and a temperature of 22 +/- 0.2 degrees C, Te was determined in the concentration range 0.08-0.85 microgram ml-1. The method was applied to the determination of Te in waters and lead concentrates.

Transient ventilatory and heart rate responses to moderate nonabrupt pseudorandom exercise

Dynamic responses of inspired minute ventilation, CO2 and O2 end-tidal gas fractions, and heart rate were obtained from six normal human volunteers in response to a complex dynamic exercise challenge. Subjects pedalled a chair ergometer at constant frequency. The retarding torque applied to the ergometer pedals was controlled by a low-pass-filtered pseudorandom binary sequence (fPRBS), which provided a complex, nonanticipatory exercise stimulus containing sufficient high- and low-frequency energy to excite the small signal, broadband ventilatory response. The exercise range was chosen to produce a mean level of O2 consumption at or below 50% maximum O2 consumption. Cross-covariant analysis of the fPRBS exercise with breath-by-breath ventilation provided an estimate of the dynamic (impulse) response to exercise, which contained both fast phase 1 and slow phase 2 components. The initial, phase one, hyperpnea occurred within the same breath as the exercise transition and preceded a hypocapnic response. The phase one hyperpnea represented 26% of the total ventilatory response. The secondary, phase 2, hyperpnea was delayed several breaths from the onset of phase 1. It contained slower dynamics and followed a hypercapnic response. Heart rate increased abruptly during phase 1, peaked near the phase 1-to-2 boundary, and then decreased rapidly. The experimental protocol was designed to minimize the subjective response and provide an adequate stimulus for the faster time constants. Results obtained from these experiments were consistent with a nonhumoral induced phase 1 exercise hyperpnea.

Angiocardiographic demonstration of a partial defect of the pericardium with herniation of the left atrium and ventricle

A case of a patient of 44 years of age with nonspecific thoracic symptomatology and anomalous protrusion of the second arch of the left border of the cardiac silhouette is reported. Cineangiocardiography showed a herniation of the left atrium and ventricle through a partial defect in the left pericardium demonstrating a mechanism that can give rise to sudden death by cardiac incarceration. Prophylactic longitudinal pericardiectomy was performed and the patient made an uneventful recovery.